Healthcare Provider Details

I. General information

NPI: 1811275738
Provider Name (Legal Business Name): ASHIRA BOWEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 N CLASSEN BLVD STE 214
OKLAHOMA CITY OK
73106-6835
US

IV. Provider business mailing address

2301 NW 122ND ST APT 3516
OKLAHOMA CITY OK
73120-8447
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-6710
  • Fax:
Mailing address:
  • Phone: 773-480-3799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: